Don’t let diabetes affect your vision

Diabetic eye disease refers to a group of eye problems that can affect people with diabetes.

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BENGALURU : Diabetic eye disease refers to a group of eye problems that can affect people with diabetes. In diabetes, our body has high blood glucose levels. This high blood glucose can damage certain tissues in our body, particularly the eyes, the kidneys, the nerves and the skin. The longer you have diabetes, your chances of developing diabetic eye disease increases, therefore an eye examination is essential for early detection.

The retina (composed of nerve fibres and blood vessels) is the back part of the eye that senses light and turns it into signals that your brain decodes, so you can see the world around you.  If your blood glucose stays high over time, it can damage the tiny blood vessels in the retina. The most serious diabetic eye diseases begin with this.  

Diabetic retinopathy

The damaged blood vessels may leak fluid and cause swelling. New and weak blood vessels may also begin to grow as abnormal new blood vessels which proliferate and cause bleeding, tractional retinal detachment, increased eye pressure or scarring and can lead to serious vision problems.

Diabetic macular oedema

The part of your retina that you need for reading, driving, and seeing faces is called the macula. Diabetes can lead to swelling and fluid accumulation in the macula, which is called diabetic macular oedema. This disease can destroy the sharp vision of the eye.

Pregnancy and diabetes

If you are diabetic and pregnant, you have increased risk of development and progression of diabetic retinopathy. So, if you are diabetic and planning to conceive, you should have an ophthalmological examination before conception to determine the baseline severity and conception should be delayed till the ocular disease is treated. 

Once conceived, an eye examination should be done again during the first trimester and subsequent examination should be every three months until delivery. Your retinopathy, which progresses during pregnancy has a high tendency for regression in the post-partum period, the length of time required for the regression is not exactly known. If you suddenly develop diabetes during pregnancy (a condition known as gestational diabetes) you are not at risk of developing retinopathy during the pregnancy.

When symptoms do occur, they may include:

•  Blurry or wavy vision
•  Dark areas or vision loss
•  Spots or dark strings (also called floaters)
•  Flashes of light

The best ways to manage your diabetes and keep your eyes healthy are to:

• Manage your blood glucose, blood pressure, and cholesterol levels.
• If you smoke, get help to quit smoking.
• It is essential to have a dilated eye examination annually; even if you feel you are asymptomatic (often you won’t feel anything). 
• Your doctor will place drops in your eyes to widen your pupils and visualise your retina using a special magnifying lens. Your vision will be blurry for a few hours after a dilated examination. 
• Vision and eye pressure are checked and other tests may be suggested to aid in diagnosis and management. 

Advanced diabetic eye disease may warrant frequent follow up and may be managed with medicine, laser treatments, surgery, or a combination of these options.

• Medical treatment: Your doctor may treat your eyes with Anti-VEGF, an injectable medicine that blocks the growth of abnormal blood vessels in the eye. It can also stop fluid leaks, which can help treat diabetic macular oedema. 
• Laser treatment: Laser treatment, also called photocoagulation, creates tiny burns inside the eye with a beam of laser light. This treats leaky blood vessels and reduces extra fluid, called oedema. This prevents your eye disease from getting worse, which is important to prevent vision loss or blindness due to bleed. 
• Vitrectomy: Vitrectomy is a surgery to remove the gel that fills the center of the eye, called the vitreous gel. The procedure treats problems with severe bleeding and helps in removal of fibrovascular tissue (proliferated new vessels into the vitreous). This fibrovascular tissue can force the retina to peel away and detach causing sudden vision loss, which requires urgent surgical intervention.

The sooner you start work on managing your diabetes and other health conditions, the better. Even if you’ve struggled in the past to manage your health, taking better care of yourself now can protect your eyes for the future. 

(The author is a senior vitreo retinal surgeon at Dr Agarwal’s  Eye Hospital Bengaluru)